Date of Award

1-1-2023

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Anne Klee

Abstract

While each US state has laws regarding emergency involuntary commitment, no study has collated them for comparison. It was hypothesized that there would be substantial variation across states, suggesting there are no established best practices for involuntary commitment law, much less evidence-based guidelines.

Using the legal software Fastcase, the relevant section of each state’s legal code was found, and imported into LawAtlas, a software for comparative legal analysis. The law was then coded using 24 of parameters.

The results showed substantial variation in legal practices across states. In most states (45), police could initiate an emergency psychiatric hold without judicial approval. In 41 states, any reasonable person could petition the court (or other state-sanctioned entity) to have a person evaluated for emergency commitment. In all 50 states, the police could transport a person in crisis to the emergency department; 13 states also allow emergency medical services to transport a person; ten states allow a mental health professional to transport a person; seven states allow for alternative custody. In terms of custody in the emergency department, eight states allow the transport to transfer custody; four states explicitly prohibit it; in the remaining states, the Code does not specify. Nine states allow a person to be held in jail during an emergency hold; 18 states explicitly prohibit it.The initial emergency hold time spanned from six hours to indefinitely. In every state, a mental health professional evaluates a person while they are in the emergency department, although the type of mental health professional varies. In 47 states, a person can be released from the emergency department without judicial approval; two states are unclear on this issue; only Virginia explicitly requires judicial approval to have a person released. In 13 states, long-term commitment proceedings must be initiated to have a person held beyond the initial emergency hold; the time to the hearing varies from two to ten days. In the remaining 37 states where there is short-term commitment, the length of short-term commitment ranged from 24 hours to 30 days. Once a person was involuntarily committed, in four states, the hospital was responsible for finding the bed; in three states, a state mental health worker found the bed; the remaining states do not specify. In 19 states, the court must certify a person for short-term commitment; in the remaining 31 states, it is the opinion of the mental health practitioner alone that allows a person to be held. In ten of these states, there is a procedure for a hearing after a person is under short-term commitment. In 24 states, a person can be released from short-term commitment based on the expertise of the mental health professional alone. In two states, the court must release a person. In the remaining 24 states, the Code does not specify.

Given this substantial variation, it was shown that there are no widely accepted legal best practices for involuntary commitment. More studies are needed so that the law can be evidence-based and support patient outcomes.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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